Does FDA’s new stance on peanut allergies have any implication to Hong Kong?

Leon Kan, 20 Sep 2017

Peanut allergy is one of the most common food allergies in the US – and the most common cause of food-allergy related death.

Peanut allergy is one of the most common food allergies in the world and also one of the deadliest. Because of its high incidence among the global population, peanut allergy is the leading cause of deaths related to food-induced allergic reactions in the United States. The problem only continues to grow as the prevalence of peanut allergies in children more than doubled in the past decade (1997 – 2008) — resulting in up to 2% of American children being allergic to peanuts.

Food allergies are not limited to just peanuts. The five most common food allergies in Hong Kong include peanuts, shellfish, eggs, dairy products and fruits.

With the threat of death and an increasing incidence, it is understandable that many young parents would be wary when it comes to feeding their children peanuts; especially if they are at a high risk. Rightfully so, that has been the status quo for avoiding peanut allergies altogether.

Until now, where the US Food and Drug Administration (FDA) has released its new stance on reducing the risk of peanut allergies in high-risk infants which moves in an entirely different direction from the previous status quo.

FDA’s new stance on peanut allergies

In a statement released on the 7 September, the FDA officially recognised a different approach to tackling peanut allergies.

The recommendation came following a landmark clinical trial funded by the National Institutes of Health (NIH), in which the consumption of peanut-containing food products actually helps lowering the risk of developing peanut allergy–going against the recommendation of avoiding any peanut-containing foods in the past. By introducing foods containing smooth peanut butter to children as early as four months of age, who are at high risk of developing a peanut allergy — due to severe eczema or egg allergy or both — it reduces the risk of developing peanut allergy in later childhood by about 80%.

Due to the discovery’s widespread implications, this is the first time the FDA has recognised a qualified health claim to prevent a food allergy. Nevertheless, the FDA remains cautious on the new recommendations, urging parents to check with their healthcare providers before introducing food products that contain traces of peanut ingredients in it.

While unprecedented, the FDA emphasises their goal is to provide parents with the latest scientific information and allow them to make more informed decision on how to best approach peanut allergies. They federal agency further iterated that they are committed to monitoring the research on peanut allergies and to update the public as new scientific information is made available.

A landmark study in understanding the development of allergies

The landmark study referred to by the FDA was a NIH-funded trial, supported by the National Institute of Allergy and Infectious Diseases (NIAID) — aimed at gaining a better understanding of the immunology of peanut allergies. Led by Gideon Lack, MD, of King’s College London, the team of researchers designed a study known as Learning Early About Peanut Allergy (LEAP).

LEAP worked by comparing two strategies to prevent peanut allergies–one via consumption and another via avoidance of peanut-containing foods–in infants, who were at a high risk of developing peanut allergy. High risk group of infants were categorised by their prior/present egg allergy and/or severe eczema. From here, more than 600 high-risk infants aged between four and 11 months were randomly assigned to either avoiding or consuming peanuts in their daily diet. The study continued until the participants were five years of age. Throughout the study period, all the participants were routinely monitored by healthcare professionals and completed dietary surveys.

The result of the study showed an overall 81% reduction of peanut allergy in children who started early, continuous consumption of peanut-containing food compared to those who were avoiding peanuts altogether. This signaled a 180-degree shift from the previous avoidance method when it came to preventing peanut allergies.

“Prior to 2008, clinical practice guidelines recommended avoidance of potentially allergenic foods in the diets of young children at heightened risk for development of food allergies,” explained Daniel Rotrosen, MD, director of NIAID’s Division of Allergy, Immunology and Transplantation. “While recent studies showed no benefit from allergen avoidance, the LEAP study is the first to show that early introduction of dietary peanut is actually beneficial and identifies an effective approach to manage a serious public health problem.”

Another study published in The Lancet, funded by the Murdoch Children’s Research Institute and Australian Food Allergy Foundation, focused on the role of immunotherapy as a potential treatment for food allergies. Through carrying out a randomised comparison between immunotherapy and a placebo-control, the team of researchers was able to ascertain the short- and long-term benefits of immunotherapy in counteracting food allergies.

By administering a combination of combined probiotic and peanut oral immunotherapy (PPOIT), the team was also able to demonstrate long-lasting clinical benefits and persistent suppression of any allergic immune response to peanuts. As such, participants within the PPOIT group were significantly more likely to continue having peanuts in their diet compared to those taking the placebo. Moreover, those in the PPOIT group displayed a lesser reaction after eating peanuts despite consuming a significantly higher amount of peanuts.

Tackling peanut allergies in Hong Kong

Nevertheless, Hongkongers with peanut allergies may not be able to benefit from the positive news from the studies due to the lack of allergists in the city. It is estimated that 21,000 people in Hong Kong suffer from peanut allergies with at least 70 allergists needed to care for this volume of patients. Unfortunately, the city only has fewer than 10 allergists with that number only having frown slightly since 2014.

“Hong Kong has a severely unmet need in allergy service provision. The lack of expertise in Hong Kong regrettably impedes its ability to take advantage of advances in allergy prevention and treatment.” said Dr Tak-hong Lee, director of the Allergy Centre at the Hong Kong Sanatorium and Hospital. While Hong Kong and Asian countries in general have a lower incidence of peanut allergies, the rate of peanut allergies in Hong Kong continues to grow. This problem is further compounded as the allergy sector in Hong Kong is severely under-resourced, only this year receiving its first trainee allergist in 20 years.

Chinese cuisine tends to be peanut rich with common dishes such as congee and soup containing the ingredient. Moreover, peanut oil is commonly used for wok-based cooking which is a big part of Chinese cuisine. While all of this may prove to be difficult for present individuals with peanut allergies, the early exposure to peanuts may just be the key for Hong Kong infants to prevent against peanut allergies. MIMS

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